Nursing 1000 Final
Terms
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Nursing Profession
What is the NLN? -
Nursing organization open to anyone interested in the field
Provides voluntary accredidation for educational programs in nursing
Sponsors continuing Ed credits
Primary source of research data about nursing education -
Nursing Profession
What is the ANA? -
ANA is the American Nurses Association
Only for Nurses/LPN/AN
Establishes Standard in nursing
Encourages research to advance nursing education
Represents nursing in the Law
Supports NSNA=National Student Nurses Association -
Legal issues
What are the six areas of negligence? -
Failure to follow stardard of care
Failure to use equipment in a responsible way
Failure to communicate
Failure to document
Failure to assess and monitor
Failure to act as a patient advocate -
Legal Issues
What is nonmalefience? - It is the duty to do no harm
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Legal issues
What is the student nurse responsible for? - they are responsible for their own actions and liable for their own acts of negligence during their clinical experiences. They are held to the same standards of skill and competence as a regerstered nurse
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Vital Signs
When taking a rectal temperature the patient will experiance tachycardia or bradycardia? - Bradycardia
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Intro to Nursing
Clara Barton was..... - Red Cross founder/Self-educated
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Intro to Nursing
The dark ages of nursing were... -
16th century to 1850
It was the decline in Religious orders
Siri Gamp character in Dickens Novel -
Intro to Nursing
Margaret Sanger was.... - individual who was considered the mother of Birth Control. She had the first birth control clinic in NYC 1916
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Intro to nursing
Definition of Nursing from the ANA 1995 -
holistic
what we see, what we hear and what the patient telss us
application of scientific knowledge
acknolwledges scientific research for it to be a profession
acknowledges caring -
Into to nursing
What is the aim and scope of Nursing? -
education
caregiver
researcher
patient advocate
counselor
communicator -
Legal issues
What 4 things prove malpractice? -
Duty
Breech of Duty
Causation (caused injury)
Harm resulted -
Legal issues
What are ethics?
What are values? -
Ethics are society standards
Values are your own personal beliefs - Preventing Ulcers
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Identify at risk patients
Assess skin Areas
Turn Client to prevent shearing
Good Hygeine to prevent infection
Good nutrition, hydration
Protect the client's skin- barrier cream
Early Intervention if ulcer is present
Head of Bed<30 to prevent sliding
heels of bed-posey boots - Types of immunity
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Active-antigens enter and body responds
Passive-antibodies exist but were not produced by that person - Active Natural Immunity
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conected with illness
most effective and long lasting - Active Artificial Immunity
- immunizations, may need boost
- Passive Natural Immunity
- breast milk, placenta, eliminated when recognized as non-self
- Active Passive Immunity
- need to avoid serious illness after exposure...rabies...venom
- Stages of Infection
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incubation:time between pathogen invading and symptoms appearing...may be 1-2 hours up to several years
prodromal: early signs and symptons appears most infectious
Full illness: symptoms very specific to illness/microorganism..may be localized,or systemic
convalescence-signs and symptoms start to wane..recovery begins - Means of transmission of bacteria:
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indirect- vehicles contaminated blood, H20 or utensils
Vectors-insects, fleas - 2 types of Asepsis
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medical: clean technique..reduce number of microorganisms and prevent spread
Surgical: Sterile technique, eliminate all microorganisms from an area - Cardinal signs of inflammatory response
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pain
swelling, edema, and fluid accumulation
local heat..increased blood flow
erythema-redness
reduction of function due to pain and swelling
Normal response to surgery...including low grade fever -
Wound Healing
Primary - incision, well approximated, no gaping edges match, heals in 4 to 14 days, depending on depth
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Wound Healing
Secondary - some tissue loss, higher infection risk, longer time to heal, scars are likely
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Wound Healing
Tertiary -
time laps between injury and suture
greater risk of infection -
Inflamation is the first phase of wound healing...it is from day 1 to day 4
4 stages are: -
1. vasoconstriction: very brief
2.vasodialation: blood to area, cleans debris, dilutes bacteria
3.phagocytosis: wbc get rid of debris-client slightly lethargic, low fever
reanastamosis-blood vessels begin to reconnect - Factors affecting wound healing
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Age
Circulatory problems
Oxygenation (smokers have co2 binds w/hemoglobin and replaces O2)
Nutrition-especially need for protein
Wound condition-size
Bacterial load-exudate
Necrotic tissue
Nsaids intfere-stop inflammatory response -
Wound Drainage
Serous - clear or light yellow, thin and watery
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Wound Drainage
Sanguinous - Red (fresh blood), thin
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Wound Drainage
serosanguinous - pink, or light red thin and watery
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Wound Drainage
purulent - yellow, green, white, tan, thick and opaque
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Wound Age
Acute - new, making progress toward healing...uncomplicated surgical wounds
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Wound Age
Chronic -
healing slow
stuck in the inflammatory stage
pressure ulcers, diabetic ulcers -
Wound Depth
partial thickness - heal quickly, involve only dermis, epidermis, painful
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Wound Depth
full thickness - penetrate though dermis and epidermis to underlying structure, slow to heal
- Types of Dressings
- dry, wet to dry, film, hydrogels, hydrocolloids, algimates, foams, imbedded
- Hydrogels
- gels or gelationous sheets, hight water content, good for a dry wound bed or sloughing wound with little drainage, requires secondary dressing like film- non absorbant
- Hydrocolloids
- for stage 1 or 2, flexible, not tramatic to the skin
- Barrier cream
- like diaper cream, keeps moisture,contaminates out
- Alginates
- made from seaweed, absorb huge amounts of fluid, require secondary dressing
- Foams
- used with wound vacs, dense, absorb moisture, insulates and maintains constant temp
- imbedded
- petroleum jelly like-scarlet red used for burns
- montgomery straps
- when patient requires frequent dressing but can't tolerate tape removal, tape plus lace up gauze...can last 2-3 weeks
- Malpractice
- negligence by a person performing as a professional and it must be proven
- Intentional torts
- include assult (threatening to touch), battery (touching), and false imprisonment
- Informed consent
- voluntary consent made by an INFORMED, competent client of legal age
- Areas of Potential Liability for nurses are......
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breach of contract
Invasion of privacy
Loss of client property
unprofessional conduct
Primary care providers' orders
recocord keeping
incident reports
giving aid to someone in distress (at scene of an accident) - Function of Law is to:
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hold nurses to be accoutable, maintain standard of nursing practice
helps to differentiate nurse responsibilities from those of other health care professionals
it specifies what is legal for nurses to perform -
Sources of Law:
Constitutional - supreme law of the USA. It creates legal rights and responsibilities and is the foundation for a system of justice
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Sources of Law:
Legislation (STATUTES) -
Laws that are enacted by federal, state, and other legislation bodies (US Senate). If federal and state conflict...federal law prevails
Regulations of Nursing is provided by the state...That is the NURSE PRACTICE ACTS -
Sources of Law:
Common Law - These are laws that evolve from court decisions. Common Law is often used to resolve disputes between two parites, as in a law suit
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Types of Law:
Public Law - law between individuals and the goverment
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Types of Law:
Criminal Law - a type of public law, it deals with safety and welfare of the public (HOMICIDE, RAPE....)
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Types of Law:
Private (civil law) - Law that deals with relationships between private persons
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Types of Laws:
Contract Law -
Enforces agreements
If a contract is written it is considered expressed
An implied contract is a verbal or an understood responsibility in a specific relationship involving services one can expect to recieve from an individual in a job or role -
Types of law:
Tort Law -
Defines duties and rights among individuals that are not based on contracts
Examples: nurse negligence, malpractice,invasion of privacy,assult and battery -
Unintentional torts
Negligence - practice that is below the standard expected of an ordinary, resonable, and prudent practitioner, placing another personat risk for harm
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Unitentional torts
Gross negligence - Extreme lack of knowledge or skill that the practicioner clearly should have known would place another at risk
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Unintentional torts
Malpractice - Negligence that occurs while the person is performing as a professional...it must be proven
- Malpractice is proven by:
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Nurse has a relationship with the client that involves providing care and is responsible for that patient
nurse did not observe standard of care that is expected
the cliet sustained harm, injury,or damage
The harm must have occured as a direct result of the nurses failure to observe the standard and the nurse should have known what was going to cause harm -
Intentional torts
Assult - an attempt to touch another person without justification....i.e Nurse says if you don't eat we will have to force feed you
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Intentional tort
Battery - Intentional touching of someone or something they are wearing. It would need to be a harmful touch, embarrassing, done without permission (continuing to bath after the client says NO!)
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Informed consent
Informed consent -
consent is voluntary
the client was competent and of legal age
Client had enough information with which to make an informed choice - Nurse Practice Act
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defines the scope of practice for the licensed nurse
protects the practice of nursing exclusively to the licensed nurse
protects the public by limiting the practice of nursing to the licensed nurse
legally controls the practice of nursing through requiered licensing - Accreditation
- is the process which the state board of nursing or other private organizations, it evaluates and approves educational programs or services that meet predetermined criteria. All nursing school must be accredited by the state board of nursing
- Florence Nightingale
- Wrote Notes on Nursing, founder of modern nursing
- Clara Barton
- American Red Cross founder
- Margaret Sanger
- Public health nurse in NYC, Founder of Planned parenthood
- Nursing is.....
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promoting health and wellness
preventing illness
restoring health
care of the dying
client based - Nursing Process
- Assessment: The nurse collects the patient health data
- Diagnosis
- the nurse analyzes the assessmnet date in determining diagnoses
- Outcome
- The nurse identifies expected outcomes individualized to the client
- Planning and implmentation
- the nurse develops a plan of care that prescribes interventions to attain expected outcomes and the nurse implements the plan of care
- Evaluation
- The nurse evaluates the patient's progress towards attainment of outcomes
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Benner's stages of Nursing expertise:
Novice= Stage 1 - Stage 1: Novice..no experience, performance is limited, inflexible, and governed bycontext-free rules and regulations rather than experience
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Benner's stages of nursing expertise:
Stage II Advanced beginner - Demonstrates marginally acceptable performance, recognizes real experiences
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Benner's Stages of Nursing expertise:
StageIII Competent - Competent: has 2 or 3 years of experience, can plan organize, multi-task
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Benner's Stages of Nursing expertise:
StageIV Proficient - Proficient-3 to 5 years experience, long term goals, sees the big picture
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Benner's Stages of Nursing expertise:
Stage V Expert - Performance is fluid, highly proficient, take action because it felt right
- Foods with phosphorus
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milk
cheese
meat
egg yolks - Foods with Potassium
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oranges
bananas
potatoes
brocoli
leafy greens
meat
nuts
legumes - Foods with Iodine
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seafood
iodized salt - Foods with vitamin c
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citrus
tomatoes
cabbage
sweet potatoes
green and yellow veggies - Foods with iron
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liver
meat
seafoods
egg yolk
whole grain
legumes
green leafy veggies - Foods with calcium
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whole grain
milk
cheese
green leafy
salmon - Foods with Vitamin D
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yeast
fish oil
fortified milk
uv ray lights - Foods with Vitamn K
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green leafy
cabbage
spinach
cauliflower
cheese
egg yolks
liver - Foods with Vitamin A
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fish oils
liver
eggs
green and yellow veggies
cantaloupe
watermelon
peaches
fortified milk - Protein Sources
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eggs
milk
fish
milk
poultry
nuts
legumes
soy proteins - Carb Sources
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grains
potatoes
corn
peas
fruits
sugar - Fat soluble vitamins
- A,D,E,K
- Water soluble vitamins
- C,B
- Lipoprotiens
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Compound lipids
HDL=good
LDL=bad - complete proteins
- provides all 9 essential amino acid in sufficient amounts for body. Animal products and soy
- Incomplete protein
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lack at least one of the essential amino acids
Plant sources Except soy - Complimentary Proteins
- two incomplete protiend that together make up all nine-this is how veggie survive i.e. peanut butter and whole grain bread
- Bronchi sounds
- low pitched gurgling as the large airways fill with air
- Crackles Sounds
- fine,coarse, popping as air passes through the fluid in the small airways
- Wheezes Sounds
- high pitched whistling as air passes through narrowed passage ways
- Friction Rub Sounds
- grating or scratching as the inflamed pleura rubs
- kyphosis
- hunchback
- lordosis
- swayback
- Six links in the chain of infection
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etiologic agent
reservoir
portal of exit
method of transmission
portal of entry to a susceptable host
susceptible host - Signs and symptoms of localized infection are:
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fever
malaise
leukocyte count>than 11,000/cu mm
enlarged lymph nodes
anorexia
nausea/vomiting - What happens when you encounter stress
- there is a release of epinephrine and cortison with subsequent changes in the organ systems
- Aldosterone
- is released from the adrenal cortex, sodium and water are reabsorbed in greater quantities increasing the blood volume and decreasing the urinary output
- signs and symptoms of stress
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dialated pupils
diaphoresis
increased heart rate
increased sodium and water retention...resulting in increased blood volume and increased cardiac output
increased rate of respirations and depth (hyperventilation)
skin pallor
decrease urinary output
dry mouth
decrease peristalsis, resulting in flatus and contriction
improved mental alertness
increased muscle tension
increased blood sugar - psychological signs and symptoms of stress
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anxiety
fear
anger
depression
unconscious ego defenses i.e.
denial
displacement
projection
rationalization
regression
sublimination - normal grief
- crying,sleep disturbances,loss of appetite,difficulty concentrating,fatigue
- dysfunctional grief
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severe physiological symptoms
suicidal thoughts
extended periods of grief
prolonged time in stage of denial
prolonged or severe social isolation
persistent guilt
low self-esteem
drug abuse - Kubler-Ross stages of dying and grieving
- Denial,Anger,Bargaining,depression,acceptance
- Gate control theory
- pain impulses can be blocked by a gate between transmission cells in the dorsal horn of the spinal cord.There is a block of too much infromation to the nerves and it could involve distraction mechanisims
- The Body's Analgesia system
- when regions of the midbrain are stimulated and endorphin opiods are released